Toyota Lean, Hospitals, The New York Times, MNA and YouTube

8 Jul

A New York Times writer is doing a Sunday business feature on Hospitals using the Toyota “Lean” model and stumbled across the MNA-created YouTube video below. So now MN Nurses are going to have a national voice in the story speaking out about unsafe staffing and hospitals putting profits ahead of patients. Like we said, our fight for safe staffing is just beginning!

30 Responses to “Toyota Lean, Hospitals, The New York Times, MNA and YouTube”

  1. Eileen W July 8, 2010 at 4:10 pm #

    Fantastic work of Captain Nemo and MNA’s terrific communications team – the best we’ve ever had since I first joined in 1980! I get the NYT online and can’t wait to read and comment.

  2. Mark Graban July 9, 2010 at 12:24 am #

    The comments on the NYT site should be interesting, since the article is a positive one about Lean at a hospital in Seattle. I am also being quoted in the article, talking about the challenges in implementing Lean – which does lead to improvements in safety, quality, and staff morale — the opposite of what you’re claiming in your YouTube video.

  3. Al C July 9, 2010 at 1:59 am #

    Mark get a clue lean at a hospital usually means do without: supplies, on time medications, help etc.

    • Mark Graban July 10, 2010 at 1:22 pm #

      Is that what it has meant at *your* hospital, in your unit? You can’t speak that generally about “what lean usually means” – what is your evidence for that?

      Lean should not mean doing without. In hospitals without lean, you often don’t have the right supplies or medications, or equipment, or information, or help.

  4. MNA RN July 9, 2010 at 2:19 am #

    ‎To Mark Graban:

    Lean business practices!
    Positive for whom?
    Big Business/CEOs?

    We already have seen what they are capable of. (environmental disasters that result in human and nature’s devastation, crashes to the economy, death of coal miners and other workers across the United States and beyond – with profit margins manning and steering their ships). I’m not just referencing the Big Business/CEOs related to Health Care. I reference their motives, methods and mentality. (and lack of humanity and moral compass).

    Human beings are not automobiles (I didn’t think it was that difficult to distiguish between the two).

    As a MNA RN I will refute Toyotas Lean Model of Nursing. Because Toyotas Lean Model KILLED people!

    And as far as believing that “newspapers” are unbiased and tell the truth (I think not)… they slant and tweak the truth especially when (sensitive) issues pertain to members of their Board of Directors that sit in the decision seats in two different arenas.

    We have only just started to fight! Our next step will be towards the capitol to get staffing language written into law. There are pages and pages of nurse’s signatures written down that have (voluntarily) signed up to continue this fight. (Oh yes, I know… those greedy nurses hogging all that hard volunteer work to themselves again).

    It is an outrageous comparison that day care facilities are mandated on how many people that are needed to take care of a given amout of children – but yet in a field where providers and caregivers actually hold patient’s lives in their hands that there is not a law governing amout of caregivers to amount of patients.

    Mr Graban, you have chosen your stance and opinion… I adamantly disagree. To such the degree that I will continue to fight for what is right… it’s something that nurses do. MNA RNs will continue the fight to bring this to legislation.

    2009 testimony of Carol Diemert, RN, MNA Practice Specialist, in support of HF441, Staffing for Patient Safety:


    • Mark Graban July 10, 2010 at 1:23 pm #

      OK, so you’re anti-business and anti-CEO. You’re laying your bias out there very clearly. What a BP oil spill has to do with Lean practices that are designed to engage all employees in improving patient care is beyond me.

      • MNA RN July 10, 2010 at 7:41 pm #

        Big Business/Big Profits… cut corners to save money. The consequential results of greed are shown to be devastating. Profits are made at the expense of “others”. It’s hard to steer your ship if you don’t have a moral compass to guide you.

      • Mark Graban July 10, 2010 at 10:50 pm #

        To say that all “big business” is only about greed, cutting corners, etc., that’s a wildly broad over-generalization, to say the least.

  5. MNA RN July 9, 2010 at 2:33 am #

    Another interesting item from NYT:

    “Toyota fell to 21st (of 33 brands) from sixth place in 2009 in the annual J. D. Power & Associates Initial Quality Study. (Business)”

    I wonder why? Imagine that. Do you think that it could possibly have anything to do with how may people were KILLED and injured by faulty automobiles directly related to their Toyota Lean philosophy? And now they want that concept to be implemented in hospitals! OMG!

    • Mark Graban July 10, 2010 at 1:25 pm #

      Seek first to understand, MNA RN. Toyota’s quality problems are not a “lean” issue. Not everything that Toyota does is a “lean” method. Their quality problems, if you study this, are not a lean production issue, these are design problems caused by growing too quickly as an organization, they aren’t manufacturing defects.

      To imply that people would be KILLED (your caps lock, not mine) by lean method in a hospital is irresponsible. What evidence is that based on?

      • MNA RN July 10, 2010 at 7:52 pm #

        “First seek to understand…” What?!
        Nurses do understand because we have to live it…
        Please you need to seek a little harder… then maybe you’ll understand. You seem to be the only one that is confused. You are trying to defend and justify “stupid”… You need to go back to the top of the page and review the video (of what you are trying so hard to promote and sell)… only this time do it with your eyes and ears open. You may have to view it (at least)three times in order for it to register in your short term memory.

  6. MNA RN July 9, 2010 at 2:35 am #

    And yet more “interesting” articles:

    Senator Barbara Boxer (CA) introduces the National Nursing Shortage Reform and Patient Advocacy Act in May of 2009, National Nurses Week.Senator Barbara Boxer Announces National RN-to-Patient Ratio Bill S1031, Part 1
    Senator Barbara Boxer introduces the National Nursing Reform and Patient advocacy Act to protect the rights of nurses to advocate for patients and set minimum nurse-to-patient ratios in hospitals. Senator Boxer is speaking to a group of nurses from across the nation who are in DC to advocate for saf…

  7. Mark Graban July 10, 2010 at 4:14 pm #

    Here is a more representative story about lean in healthcare, I believe:

    “Andy” is lean healthcare coach in Ireland:

    “Removing waste from work doesn’t always start with an efficiency study. Andy emphasizes that a focus on cost cutting doesn’t usually create a lot of commitment, but that hospital workers want to improve care. And improving care reduces costs in many instances.

    Andy worked with one hospital to reduce injuries due to falls. Employees focused attention on the position of patients, making sure they were seated or in bed at a height they could stand up from, for example. Data showed that many falls occurred during shift changes, when patients tried to do on their own what they needed help with: going to the bathroom or getting water. Ensuring that shift change didn’t cause gaps in patient assistance made a difference. Visual controls were used to flag patients who were fragile or otherwise had a greater risk of falls, so closer attention would be paid to their safety.

    Other initiatives focused on what nurses were spending their time doing. It’s typical to find that they spend large chunks of time walking or searching for things. When 1,000 small improvements can be made in a week of effort, labeling and changing storage locations can begin to melt away the waste and put nurses at the bedside, where they really want to be. When nurses are with the patients, there are fewer falls, mistakes, and other adverse outcomes. The important thing is that the nurses themselves, along with other patient care and support staff, identify changes and implement them. Management supports and sustains the process, but it’s owned by the people who do the work.”

    • MNA RN July 10, 2010 at 7:32 pm #

      Whatever you are trying to “sell”… I’m not buying. And, neither will other MNA RNs. Someone needs to put a sign out by the front door: No solicitation. You sound like a salesperson. What’s your commission?

      • Mark Graban July 10, 2010 at 10:51 pm #

        I’ll give you the benefit of the doubt that you’re also trying to help nurses and patients, just like I am.

        What are you selling? The union.

        What am I selling — ideas that help improve healthcare, as the NY Times article (which is now out) shows.

      • MNA RN July 13, 2010 at 7:00 am #

        Mark Graban:
        You really should be more discerning when reading a newspaper. We as nurses have learned that newspapers are not very accurate in what they print or the pictures that they try to paint. Those that think with their own minds can tell the difference.

  8. Jackson VonHammerstein July 11, 2010 at 2:24 am #

    Hey, goofs! Over the past three years, Toyota has begun migrating away from the Lean business philosophy. All of you need to pay more attention to what is happening!

  9. Allina Nurse July 12, 2010 at 3:50 pm #

    The word LEAN itself speaks volumes, scary!

    • Mark Graban July 12, 2010 at 9:31 pm #

      Closed minded-ness is also scarey.

      What, exactly, in the NY Times article would you have a problem with in your hospital?

      I honestly would like to hear somebody’s feedback on this.

      • MNA RN July 13, 2010 at 6:31 am #

        We keep giving you feedback. You just don’t like the responses. Maybe if you keep trying you may find one… but I don’t think you are going to find it from a nurse. It’s a very difficult mission to try to convince a nurse of something that they KNOW is nonsensical. If its wrong… it’s wrong… straight up. Maybe you need a different audience to present to. Maybe in a comedy club?

      • MNA RN July 13, 2010 at 6:48 am #

        You seem to forget who’s home page you are on here. This is where MNA RNs are at. May I suggest that you visit MNA RNs Facebook page… I’m sure you will get all the feedback that you are looking for there (or not). Just take your fingers out of your ears when they tell you.

  10. MNA RN July 13, 2010 at 6:44 am #

    Mark Graban… are you a nurse? Just wondering… or are you one of those people that are self proclaimed “experts” at trying to tell nurses how to be nurses… you try to micromanage something that should be in the nurses area of expertise. It’s the nurses that know what works and what doesn’t work. You try to impose these proposals onto nuses and just expect them to say: “Oh wow, that really makes sense… we need to do this right away, what a wonderful new scheme for us to implement”… why don’t you just line up a bunch of rings for us to jump through. We do not blindly follow something just because we are told that we should be jumping. We are caregivers, we safeguard our patients from craziness such as what you are lovingly trying to promote… Also, just wondering… how many actual practicing bedside/front line nurses actually were involved in developing this wonderful new program of yours? Inquiring minds would like to know.

  11. Mark Graban July 13, 2010 at 12:37 pm #

    To the anonymous union blogger… are you nurse or just a union administrator? I am posting under my own name and if you want to know my background, I provide links to my blog.

    I am not a nurse. I have worked well with nurses in many hospitals. This is not at all about “me telling nurses what to do.”

    There are many bedside/front line nurses involved with Lean in hospitals. “This stuff just makes sense” is what many say, especially when the improvements make their day less frustrating, when they’re not searching for supplies, when managers are listening to their ideas, and when they have more time for patient care.

    I’m not asking you to blindly follow anything. In fact, what I’m encouraging you to do is open your eyes to the good things that are happening out there. You may have had bad experiences with that somebody called “lean” in your hospital. Or, you’re closed-minded and have an irreparable grudge against management that blinds you to seeing anything positive with Lean.

    I won’t be able to convince you, apparently, that although I’m not a nurse, I am a caring, patient-centered person.

  12. Nick July 13, 2010 at 3:27 pm #

    An interesting study by two economists:

    “This study provides some of the first analytical evidence on the effects of health care strikes on patients, and suggests that hospitals functioning during nurses’ strikes are doing so at a lower quality of patient care.”

  13. Erik July 13, 2010 at 5:14 pm #

    Mark, thank you for your thoughts and comments. I am a nurse, and have as well grappled with “MNA RN” to discuss key issues only to be acused of “inciting negativity.” MNA RN, yes, this is a MNA blog forums, but it’s also public. I have posted several times about how the LEAN process has been very beneficial to my job and work processes. Your argumentation continues to be fallicious and full of assumptions with out evidence or warrants.

    Good patient care is not soley up to nurses, but the team effort from providers, nurses, assistants, management, IT professionals, house keepers, kitchen staff, and the people that pack surgical kits. When we make this all about nurses, we lack focus and some attention from the hard working individuals like Mark and his blog that teaches us about new methods of efficiency that can give us tools to serve our clients better, faster.

    It’s my opinion that your paranoia to newpaper media makes are argumentation look weak, as you’re not willing to use sources from media reporting on the news. Just because the Strib posted articles that went against the crusade, doesnt make them biased or in the pockets of anyone. It’s called investigative journalism.

    I too post under my name. Perhaps you should step up and tell us yours, MNA RN. Mark, thank you again for being a positive voice for evidence, and the persuit of knowledge and education.

  14. Michelle July 15, 2010 at 7:12 am #

    I’m a nurse too and I fail to see how LEAN is such a problem for our profession. All I see is the rhetoric that “patients aren’t cars” which shows a huge lack of understanding regarding the Lean process. Granted, I’m rather new to this Lean concept, but based on the information presented “continuous improvement with respect to humanity” hardly seems like it would harm patients. Examples mentioned in articles provided outline how improving access to supplies assisted nurses in spending less time hunting down materials and allowing them to spend more time with patients. How is that a bad thing???
    I can see how this process was started in my hospital just prior to my hire date a couple years ago. All the supply rooms had color coded bins added to assist in finding supplies. Not only is it easier to find supplies on my own floor, but when I have to float to a sister unit I don’t have to struggle to find the items I need. Additionally, all the bins have bar codes and stock is reviewed regularly so we always have supplies. If this is Lean than bring more please!

    Thank you Mark for speaking up and sharing your blog with us. Those who are capable of rational thought really appreciate it.

  15. Will July 15, 2010 at 8:42 pm #

    I think the issue MNA RN has is with the connation of the word “LEAN”, which many who have not been educated in these principles might take as a buzz word for “understaffed” or “less staff”, or simply “cheapest possible way”. That said, all of us who know and practice LEAN understand the methodology is about improving process, not mandating staffing or dictating the time it should take to perform a task. It’s apparent MNA RN does not want to learn about LEAN, but simply further an agenda against hospital administration. It’s quite unfortunate, because LEAN methodologies may really help MNA RN and his/her fellow nurses enhance patient care.


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